TOWN OF LEICESTER 132 Main Street Post Office Box 197 Leicester, New York 14481 Phone: (585) 382-3231 FAX: (585) 382-9766 BUILDING PERMIT APPLICATION All Town of Leicester property owners are required to comply with all the regulations as set forth by New York State Building Code and the Zoning Code of the Town of Leicester. INSTRUCTIONS: a. This application is to be filled in by typewriter or in ink and submitted with 2 sets of plans and specifications to the Code Enforcement Officer. b. A copy of the approved Zoning Application (if applicable) accompany this Building Permit Application. c. The work covered by this application shall not be commenced before the issuance of a Building Permit. d. Upon approval of the Application, the Code Enforcement Officer will issue a Building Permit to the applicant and return one set of the Plans and Application. The approved Plans shall be kept on the premises during the progress of the work. e. No building shall be occupied or used in whole or part for any purpose until a Certificate of Occupancy shall have been granted by the Code Enforcement Officer. f. All new construction of buildings, additions and alterations must comply with the New York State Uniform Fire Prevention and Building codes. g. A building permit shall authorize the commencing of work and shall be effective for a period of six ( 6) months after the date of issuance. For good cause, the Code Enforcement Officer may allow a maximum of two (2) extensions for periods not exceeding three (3) months each. Application is Hereby Made to the Code Enforcement Officer for the issuance of a Building Permit, pursuant to the code of the Town of Leicester for the building structure, additions, alterations or relocation as herein described. The applicant shall comply with all applicable laws, ordinances and regulations. Signature of Applicant # Street or Road Date Town or City State Zip Code 1. Address where work will be done Tax Map No. 2. Present Use Intended use and occupancy 3. Nature of Work and Occupancy. Construction of a new building Addition to building Alteration to building Demolition of a building Installation of oil or gas burner, describe: Installation of plumbing, describe: Installation of electric, describe: Other work, describe: One Family dwelling with attached garage Two family dwelling with attached garage Multiple dwelling with attached garage Commercial/Professional Other type occupancy Accessory Building One car detached garage Two-car detached garage Private storage building Shed Enter description here: OFFICIAL USE 1 Building Fee $ Date Received Date Paid
4. Estimated true value of improvements 5. Dimensions of new structures Area sq. ft. 6. Dimensions of additions Area sq. ft. 7. Dimensions of alteration Area sq. ft. 8. The Name, address and telephone number of the Owner is: (please print) 9. The plot diagram should show location of all buildings, existing or proposed, together with dimensions from property lines, the surface elevation of front yard at the front wall of the principal building as related to the surface of the street or highway. Lot number, street names, type of lot (interior or comer) and a lot description need to be included. 10. Is a Flood Permit Application required? Yes No This permit is issued subject to the provisions of section 57 of the workman's Compensation Law. In issuance of the permit the Town assumes no responsibility regarding the performance or quality of work, except as provided by law. I HEREBY CERTIFY THAT I AM THE and that I am duly authorized to make and file this application; that all statements contained in this application are true to the best of my knowledge and belief, and that the work will be performed in the manner set forth in this application and in the plans filed herewith. Date Name and Address of Contractor Insurance Company Signature of Applicant Attach a Certificate of Insurance Date Zoning Officer (Approved) (Disapproved) If disapproved, reason for Disapproval 2
PLOT DIAGRAM/SURVEY MAP Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setback dimensions from property lines. Give identifying information or deed description, show all easements and street names, adjacent property owner names. Indicate whether this is an interior or a comer lot. Show any water bodies or creeks, shorelines. If there is not enough room below, you may use page 4 or include a separate drawing. 3
PLOT DIAGRAM/SURVEY MAP 4
MATERIAL LIST (circle 1 or more) ADDITION BATH KITCHEN ROOM GARAGE BARN DECK PORCH OTHER ALTERATION BATH KITCHEN BASEMENT DECK PORCH OTHER 1. Foundation: Footing Size Concrete Strength Reinforcing 2. Foundation Wall: Concrete Size Cement Block Size Other Concrete Work: Floor Sidewalk 3. Framing Other Reinforcing Outside Walls: Studs Sheathing Inside Walls: Studs 1st Floor Joist 2nd Floor Joist Subflooring Subflooring Ceiling Joist Rafters Truss Sheathing Treated Poles Size 4. Insulation: Foundation 1st Floor Ceiling at Roof Sidewalls Other 5
MATERIAL LIST 5. WALL FINISH: Outside Walls Ceiling 6. ROOFING: Type Drip Edge 7. HEATING: Type Existing 8. PLUMBING: New Additional Sink Lavatory Water Closet Interior Walls Floor Felt Other New Supplemental Reuse Type of Piping Bathtub Shower Stall Shower 9. ELECTRIC: Laundry New Service- Yes New Panel- Yes Number Outlets - Smoke Detector - No No Number Switches- Use of G.F.I.- 10. MISCELLANEOUS: Cabinets: Windows: Doors: Stairs: Driveway: 6